Alternative and Complementary Therapies

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People often turn to alternative and complementary therapies (ACT) to seek symptom relief and to support health in general. Several studies indicate that therapies such as yoga, acupuncture, and other ACTs can help ameliorate symptoms such pelvic pain and provide overall support for health and well-being. Due caution is important when a product claims to be a “cure”. Before use, any therapy should be discussed with your provider. Here are a few things that have been studied:

Yoga

  • Goncalves, A. V., Barros, N. F., & Bahamondes, L. (2017). The practice of hatha yoga for the treatment of pain associated with endometriosis. The journal of alternative and complementary medicine, 23(1), 45-52. Retrieved from https://www.liebertpub.com/doi/abs/10.1089/acm.2015.0343 

“Results: The degree of daily pain was significantly lower among the women who practiced yoga compared with the non-yoga group (p = 0.0007). There was an improvement of QoL in both groups between baseline and the end of the study evaluation. In relation to EHP-30 domains, pain (p = 0.0046), impotence (p = 0.0006), well-being (p = 0.0009), and image (p = 0.0087) from the central questionnaire, and work (p = 0.0027) and treatment (p = 0.0245) from the modular questionnaire were significantly different between the study groups over time. There was no significant difference between the two groups regarding the diary of menstrual patterns (p = 0.96). Conclusions: Yoga practice was associated with a reduction in levels of chronic pelvic pain and an improvement in QoL in women with endometriosis.”

*QoL – Quality of Life, EHP-30 – Endometriosis Health Profile

  • Gonçalves, A. V., Makuch, M. Y., Setubal, M. S., Barros, N. F., & Bahamondes, L. (2016). A qualitative study on the practice of yoga for women with pain-associated endometriosis. The journal of alternative and complementary medicine, 22(12), 977-982. Retrieved from https://www.liebertpub.com/doi/abs/10.1089/acm.2016.0021   

“Results: All participants reported that yoga was beneficial to control pelvic pain. They related that they were aware of the integration of body and psyche during yoga practice and that this helped in the management of pain. Women said they had identified a relationship between pain management and breathing techniques (pranayama) learned in yoga and that breathing increased their ability to be introspective, which relieved pain. The participants have developed greater self-knowledge, autonomy, and self-care and have reduced the use of pain and psychiatric medications. They created ties among themselves, suggesting that the yoga group allowed psychosocial support. Conclusions: Bodily and psychosocial mechanisms to control pain were identified in women with endometriosis. To reach such control, it is crucial that mind and body integrative techniques are learned.”

“Interventions included yoga, mindfulness, relaxation training, cognitive behavioural therapy combined with physical therapy, Chinese medicine combined with psychotherapy, and biofeedback. Results indicate that no studies have yet used gold-standard methodology and, thus, definitive conclusions cannot be offered about PMB efficacy. However, the results of these pilot studies suggest that PMB interventions show promise in alleviating pain, anxiety, depression, stress and fatigue in women with endometriosis, and future well-designed RCTs including active control groups are warranted.”

  • Saxena, R., Gupta, M., Shankar, N., Jain, S., & Saxena, A. (2017). Effects of yogic intervention on pain scores and quality of life in females with chronic pelvic pain. International Journal of Yoga, 10(1), 9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225749/

“Results: After 8 weeks of yogic intervention, Group II patients showed a significant decrease in intensity of pain seen by a decrease in VAS score (P < 0.001) and improvement in the quality of life with a significant increase (P < 0.001) in physical, psychological, social, and environmental domain scores of WHOQOL-BREF. Conclusions: The practice of yoga causes a reduction in the pain intensity and improves the quality of life in patients with chronic pelvic pain.”

*WHOQOL-BREF – World Health Organization Quality of Life

“Conclusion: The results support the use of yoga to improve pain and QOL in women with CPP. Future studies should aim to determine the minimal dosage needed for a successful yoga intervention and use a randomized controlled design with assessor blinding to increase the quality of evidence.”

*QOL- quality of life, CPP – chronic pelvic pain

Acupuncture:

  • Kong, S., Zhang, Y. H., Liu, C. F., Tsui, I., Guo, Y., Ai, B. B., & Han, F. J. (2014). The complementary and alternative medicine for endometriosis: a review of utilization and mechanism. Evidence-Based Complementary and Alternative Medicine, 2014. Retrieved from https://www.hindawi.com/journals/ecam/2014/146383/  

“Acupuncture therapy includes needling, auricular point, and moxa-moxibustion. It has the function of dredging meridian, regulating the balance of Yin and Yang (Chinese medicine believes that the balance of Yin and Yang determines people’s health), enhancing “Qi-Blood” circulation, thereby strengthening body’s resistance to disease and eliminating pathogenic factors. In clinic, acupuncture therapy for EM is confirmed to improve efficacy with fewer side effects, especially in EM-associated dysmenorrhoea. Acupuncture analgesia is usually used to treat pelvic pain and dysmenorrhoea related to EM by mediating the central nervous system (CNS) and releasing some specific neurotransmitters.”

*Dysmenorrhoea- pain with menstruation

“Recent advances in neuroendocrinology and immunology have provided an entry to understand acupuncture….estrogen promotes the endometriosis progression through on-site inflammation. Current treatments for endometriosis involve hormonal therapy and surgical procedures, however, they both may induce several side effects. Several studies have shown that the administration of exogenous dopamine agonists can significantly suppress endometriosis progression. Acupuncture is multivalent in which it can simultaneously stimulate the secretion of endogenous dopamine to modulate the GnRH neuroendocrine pathway in CNS and the COX-2 inflammatory pathway in PNS. Hence, acupuncture can smoothly manage endometriosis without the side effects of exogenous dopamine. The endometriosis management by acupuncture provides us an example of how to incorporate acupuncture into current biomedical systems. Acupuncture may provide a convenient, physiological method to regulate the neuroendocrine system in an integrative, systematic means.”

“To test the efficacy of acupuncture, we selected 42 women who were on the waiting list to undergo a video laparoscopy at the University Hospital of Florianópolis, Santa Catarina, Brazil. These women were divided into two sample groups. The first received the experimental treatment of acupuncture, and the other received placebo therapy, for which the needles were inserted 3 cm apart from the points of energy. Each group underwent five treatment sessions lasting on average 40 min. Randomization was carried out using Clinical Trial Management System software, and the allocation sequence was performed by a laboratory assistant and hidden to the team conducting the project, which was responsible for collecting the information. To monitor the effects of this intervention, we used the visual analogue scale (VAS) and the quality-of-life questionnaire for Endometriosis Health Profile 30 (EHP-30) endometriosis. Variables were measured at three time points: pre-therapy, post-therapy, and 2 months after therapy. Results: The results were analysed with SAS software version 9.1.3 using analysis of variance. A decrease in VAS scores for chronic pelvic pain and dyspareunia was observed in both groups analysed. However, 2 months after therapy, the results were maintained only in the experimental group. Regarding quality of life, we observed an improvement in all variables analysed, although these were statistically significant only in the experimental group. In contrast, the variable for infertility did not reach significance in either group. Conclusions: We concluded that acupuncture confers beneficial and long-lasting effects, even 2 months after therapy, as demonstrated by the variables studies.”

“Twenty‐four studies were identified that involved acupuncture for endometriosis; however only one trial, enrolling 67 participants, met all the inclusion criteria. The single included trial defined pain scores and cure rates according to the Guideline for Clinical Research on New Chinese Medicine. Dysmenorrhoea scores were lower in the acupuncture group (mean difference ‐4.81 points, 95% confidence interval ‐6.25 to ‐3.37, P < 0.00001) using the 15‐point Guideline for Clinical Research on New Chinese Medicine for Treatment of Pelvic Endometriosis scale. The total effective rate (‘cured’, ‘significantly effective’ or ‘effective’) for auricular acupuncture and Chinese herbal medicine was 91.9% and 60%, respectively (risk ratio 3.04, 95% confidence interval 1.65 to 5.62, P = 0.0004). The improvement rate did not differ significantly between auricular acupuncture and Chinese herbal medicine for cases of mild to moderate dysmenorrhoea, whereas auricular acupuncture did significantly reduce pain in cases of severe dysmenorrhoea.”

“Results: Three studies were found including 99 women, 13–40 years old, with diagnosed endometriosis. The studies were different in research design, needle stimulation techniques, and evaluation instruments. Methodological similarities were seven to12 needle insertions per subject/session, and 15–25 minutes of needle retention time. The needles were placed in lower back/pelvic-abdominal area, in the shank, feet, and hands. Treatment numbers varied from nine to 16 and patients received one to two treatments per week. Similarity in reported treatment effects in the quoted studies, irrespective of research design or treatment technique, was reported decrease of rated pain intensity. Conclusion: Endometriosis is often painful, although with various origin, where standard treatments may be insufficient or involve side effects. Based on the reported studies, acupuncture could be tried as a complement as it is an overall safe treatment. In the future, studies designed for evaluating effectiveness between treatment strategies rather than efficacy design would be preferred as the analyses of treatment effects in the individual patients.”

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